Dosing & Uses
Dosage Forms & Strengths
injectable solution
- 10mg/mL
- 40mg/mL
Intravenous solution
- 60mg (50mL)
- 70mg (50mL)
- 80mg (50mL, 100mL)
- 90mg (100mL)
- 100mg (50mL, 100mL)
- 120mg (100mL)
Susceptible Infections
In underweight and nonobese patients, use of total body weight (TBW) instead of ideal body weight for determining initial mg/kg/dose is accepted; ideal body weight (IBW) also may be used to determine doses for patients who are neither underweight nor obese
Conventional dosing
Extended dosing interval
- Initial: 5-7 mg/kg/dose IV qDay
- Not for use in patients with ascites, burns covering >20% of total body surface area, cystic fibrosis, end-stage renal disease, endocarditis, infants, mycobacterial infections, or pregnancy
- Measure gentamicin level between 6 and 14 hr after initiating gentamicin infusion; use institution-specific nomogram to determine appropriate dosing interval
Surgical Prophylaxis (Off-label)
5 mg/kg IV as single dose 1 hr prior to surgical incision; alternativley, 1.5 mg/kg IV as single dose for gynecology procedures
Dose is based on actual body weight (TBW) unless body weight is >20% above ideal body weight (IBW), in which case the dosing weight can be estimated by IBW + 0.4 (TBW - IBW)
Infective Endocarditis Treatment
Enterococcus (native or prosthetic valve); Off-label dose
- 3 mg/kg/day IV/IM divided q8hr for 4-6 weeks in combination with a beta-lactam and for 6 weeks when administered wiht vancomycin
- Organism sensitivity testing should determine choice of concomitant antiibotic and treatment duration
S. aureus (prosthetic valve; methicillin susceptible or resistant); Off-label dose
- 3 mg/kg/day IV/IM divided q8-12hr for 3-5 days for native valve infections or for 2 weeks for prosthetic valve infections in combination with other antibiotic
- Organism sensitivity testing should determine choice of concomitant antibiotic
Viridans group streptococcus and S bovis (native or prosthetic valve); Off-label use
- 3 mg/kg/day IV/IM qDay (preferred) or divided q8hr for 2 weeks for native or prosthetic valve infections or for 6 weeks for prosthetic valve infections with relatively or fully resistant strains in combination with other antibiotic
- Organism sensitivity testing and source of infection should determine choice of concomitant antibiotic
Cystic Fibrosis (Off-label)
7.5-10.5 mg/kg/day IV/IM divided q8hr
Pelvic Inflammatory Disease (Off-label)
Loading dose: 2 mg/kg IV or IM
Maintenance dose: 1.5 mg/kg IV/IM q8hr plus clindamycin IV or 3-5 mg/kg IV qDay
May initiate transition from parenteral to oral therapy of either oral doxycycline or oral clindamycin within 24-48 hr of clinical improvement for total treatment duration of 14 days
Plague (Yersinia pestis) Treatment (Off-label)
5 mg/kg IV/IM qDay for 10 days or 2 mg/kg IV/IM loading dose; then 1.7 mg/kg/dose IV/IM q8hr for 10-14 days or until 2 days after patient is afebrile; doxycycline, ciprofloxacin, or chloramphenicol could be used as third-line alternatives
Dosage Modifications
Renal impairment
-
Conventional dosing
-
Once daily (interval adjustment of extended interval dosing)
-
Intermittent hemodialysis
- Administer after hemodialysis on dialysis days
- Dependent on patients size, site of injection, filter, duration and type of intermittent hemodialysis, it is ~30-50% dialyzable
- 1-1.7 mg/kg IV/IM after initial hemodialysis session; serum gentamicin concentrations should guide subsequent dosing
- Dosing dependent on assumption of 3 times/wk complete intermittent hemodialysis sessions
-
Peritoneal dialysis
- Intermittent dosing: 0.6 mg/kg per exchange once daily for anuric patients; 0.75 mg/kg/dose IP for non-anuric patients qDay during long dwell periods; depending on infecting organism and patient's clinical status, may treat for 2-3 weeks
- Continuous dosing: 8 mg/L loading dose; followed by 4 mg/L maintenance dose
-
Continuous renal replacement therapy
- Drug clearance is highly dependent on method of renal replacement, filter type, and flow rate; close monitoring of pharmacologic response, sign of adverse reactions due to accumulation, and target drug concentration necessary for appropriate dosing
- 3 mg/kg/day IV/IM divided q8hr; may administer up to 5 mg/kg/day IV/IM divided q6-8hr in life-threatening infections; peak; adjust dose based on serum concentration monitoring; peak concentration >12 mcg/mL should be avoided
Dosing Considerations
Gentamicin may be administered IV/IM
Infuse over 30-120 min when administering IV
Dosing regimens are numerous and are adjusted based on CrCl and changes in volume of distribution, as well as on the body space where distribution of the agent will occur
Monitor peak (4-12 mg/L) and trough (1-2 mg/L)
Monitor nephrotoxicity, neurotoxicity, and ototoxicity; assess at beginning of therapy and throughout
Each regimen must be followed by at least trough level drawn on third or fourth dose, 30 min before dosing unless renal toxicity suspected
May draw peak level 30 min after 30-min infusion has been completed or 1 hr after IM injection
Use ideal body weight for mg/kg/dose; more accurate than total body weight
Gentamicin is usually a first-line aminoglycoside against infections with gram-negative organisms such as Pseudomonas aeruginosa, Proteus, Escherichia coli, Klebsiella, Enterobacter, Serratia, and Citrobacter, as well as against Staphylococcus (gram- positive)
Bacterial organisms causing susceptible infections
- Susceptible infections include the following:
- Pseudomonas aeruginosa
- Proteus species (indole-positive and indole-negative)
- Escherichia coli
- Klebsiella-Enterobacter-Serratia species
- Citrobacter species
- Staphylococcus species (coagulase-positive and coagulase-negative)
- Pseudomonas aeruginosa
- Proteus species (indole-positive and indole-negative)
- Escherichia coli
- Klebsiella-Enterobacter-Serratia species
- Citrobacter species
- Staphylococcus species (coagulase-positive and coagulase-negative)
Mycobacterium Infection (Orphan)
Gentamicin liposome injection: For disseminated Mycobacterium avium-intracellulare infection
Orphan indication sponsor
- Liposome Company, Inc; One Research Way; Princeton, NJ 08540
Dosage Forms & Strengths
injectable solution
- 10mg/mL
- 40mg/mL
Intravenous solution
- Intravenous solution
- 60mg (50mL)
- 70mg (50mL)
- 80mg (50mL, 100mL)
- 90mg (100mL)
- 100mg (50mL, 100mL)
- 120mg (100mL)
Susceptible Infections
Use of ideal body weight (IBW) for determining the mg/kg/dose appears to be more accurate than on the basis of total body weight (TBW)
Infants: 2.5 mg/kg/dose IV/IM q8hr
Children and adolescents:: 2-2.5 mg/kg/dose IV/IM q8hr
<30 weeks' gestation
30-36 weeks' gestation
>36 weeks' gestation
Surgical Prophylaxis, Preoperative (Off-label use)
2.5 mg/kg IV/IM within 60 min piror to surgical incision or without antibiotics; procedure dependent
Dose is based on actual body weight unless >20% above ideal body weight; then dosage requirement may best be estimated using a dosing weight of IBW + 0.4 (TBW- IBW)
Dosage Modifications
GFR>50 mL/min/1.73m²: No dosage adjustment necessary
GFR 30-50 mL/min/1.73m²: Administer q12-18hr
GFR 10-29 mL/min/1.73m²: Administer q18-24hr
GFR <10 mL/min/1.73m² Administer q48-72hr
Intermitent hemodialysis: 2 mg/kg/dose; redose as indicated by serum concentration
Peritoneal dialysis: 2 mg/kg/dose; redose as indicated by serum concentration
Continuous renal replacement therapy: 2-2.5 mg/kg/dose q12-24hr; monitor serum concentration
Dosing Considerations
Monitor peak (4-12 mg/L) and trough (1-2 mg/L)
Monitor nephrotoxicity, neurotoxicity, and ototoxicity; assess at beginning of therapy and throughout
Individualization critical due to low therapeutic index
Use ideal body weight for mg/kg/dose, except in neonates (in whom actual body weight should be used)
Bacterial organisms causing susceptible infections
- Pseudomonas aeruginosa
- Proteus species (indole-positive and indole-negative)
- Escherichia coli
- Klebsiella-Enterobacter-Serratia species
- Citrobacter species
- Staphylococcus species (coagulase-positive and coagulase-negative)
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (23)
- agalsidase alfa
gentamicin decreases effects of agalsidase alfa by pharmacodynamic antagonism. Contraindicated.
- agalsidase beta
gentamicin decreases effects of agalsidase beta by pharmacodynamic antagonism. Contraindicated.
- amphotericin B deoxycholate
amphotericin B deoxycholate and gentamicin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.
- atracurium
gentamicin increases effects of atracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.
- bacitracin
gentamicin and bacitracin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug. Avoid concurrent use of bacitracin with other nephrotoxic drugs
- BCG vaccine live
gentamicin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- bumetanide
bumetanide, gentamicin. Either increases toxicity of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased risk of ototoxicity and nephrotoxicity.
- cholera vaccine
gentamicin, cholera vaccine. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid coadministration of cholera vaccine with systemic antibiotics since these agents may be active against the vaccine strain. Do not administer cholera vaccine to patients who have received oral or parenteral antibiotics within 14 days prior to vaccination.
- cidofovir
cidofovir and gentamicin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.
- cisatracurium
gentamicin increases effects of cisatracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.
- ethacrynic acid
ethacrynic acid, gentamicin. Either increases toxicity of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased risk of ototoxicity and nephrotoxicity.
- furosemide
furosemide, gentamicin. Either increases toxicity of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased risk of ototoxicity and nephrotoxicity.
- incobotulinumtoxinA
gentamicin increases effects of incobotulinumtoxinA by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.
- neomycin PO
gentamicin and neomycin PO both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.
- onabotulinumtoxinA
gentamicin increases effects of onabotulinumtoxinA by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.
- pancuronium
gentamicin increases effects of pancuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.
- quinidine
quinidine will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.
- rapacuronium
gentamicin increases effects of rapacuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.
- rocuronium
gentamicin increases effects of rocuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.
- succinylcholine
gentamicin increases effects of succinylcholine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.
- torsemide
torsemide, gentamicin. Either increases toxicity of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased risk of ototoxicity and nephrotoxicity.
- typhoid vaccine live
gentamicin decreases effects of typhoid vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- vecuronium
gentamicin increases effects of vecuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.
Monitor Closely (162)
- abobotulinumtoxinA
gentamicin increases effects of abobotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Aminoglycosides may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.
- acebutolol
acebutolol increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- aceclofenac
aceclofenac increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- acemetacin
acemetacin increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- acyclovir
acyclovir and gentamicin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- albuterol
albuterol and gentamicin both decrease serum potassium. Use Caution/Monitor.
- amikacin
amikacin and gentamicin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.
- amiloride
amiloride increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- amiodarone
amiodarone will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- arformoterol
arformoterol and gentamicin both decrease serum potassium. Use Caution/Monitor.
- aspirin
aspirin increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- aspirin rectal
aspirin rectal increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- aspirin/citric acid/sodium bicarbonate
aspirin/citric acid/sodium bicarbonate increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- atenolol
atenolol increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- bazedoxifene/conjugated estrogens
gentamicin will decrease the level or effect of bazedoxifene/conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.
- bendroflumethiazide
bendroflumethiazide and gentamicin both decrease serum potassium. Use Caution/Monitor.
- betaxolol
betaxolol increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- bisoprolol
bisoprolol increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- bumetanide
bumetanide and gentamicin both decrease serum potassium. Use Caution/Monitor.
- candesartan
candesartan increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- capreomycin
capreomycin and gentamicin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- carbenoxolone
carbenoxolone and gentamicin both decrease serum potassium. Use Caution/Monitor.
- carboplatin
carboplatin and gentamicin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- carvedilol
carvedilol increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- celecoxib
celecoxib increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- celiprolol
celiprolol increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- cephaloridine
cephaloridine and gentamicin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- chlorothiazide
chlorothiazide and gentamicin both decrease serum potassium. Use Caution/Monitor.
- chlorthalidone
chlorthalidone and gentamicin both decrease serum potassium. Use Caution/Monitor.
- choline magnesium trisalicylate
choline magnesium trisalicylate increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- cisplatin
cisplatin and gentamicin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- clarithromycin
clarithromycin will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- clotrimazole
clotrimazole will decrease the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- colistin
colistin and gentamicin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- conjugated estrogens
gentamicin will decrease the level or effect of conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.
- contrast media (iodinated)
contrast media (iodinated) and gentamicin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.
- cyclopenthiazide
cyclopenthiazide and gentamicin both decrease serum potassium. Use Caution/Monitor.
- cyclosporine
cyclosporine and gentamicin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.
- deferasirox
deferasirox, gentamicin. Other (see comment). Use Caution/Monitor. Comment: Acute renal failure has been reported during treatment with deferasirox. Coadministration of deferasirox with other potentially nephrotoxic drugs, including aminoglycosides, may increase the risk of this toxicity. Monitor serum creatinine and/or creatinine clearance in patients who are receiving deferasirox and nephrotoxic drugs concomitantly.
- deflazacort
gentamicin and deflazacort both decrease serum potassium. Use Caution/Monitor.
- dichlorphenamide
dichlorphenamide and gentamicin both decrease serum potassium. Use Caution/Monitor.
- diclofenac
diclofenac increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dienogest/estradiol valerate
gentamicin will decrease the level or effect of dienogest/estradiol valerate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor. An alternate or additional form of birth control may be advisable during concomitant use.
- diflunisal
diflunisal increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- digoxin
gentamicin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.
digoxin increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. - dobutamine
dobutamine and gentamicin both decrease serum potassium. Use Caution/Monitor.
- dopexamine
dopexamine and gentamicin both decrease serum potassium. Use Caution/Monitor.
- dronedarone
dronedarone will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- drospirenone
drospirenone increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- elvitegravir/cobicistat/emtricitabine/tenofovir DF
gentamicin and elvitegravir/cobicistat/emtricitabine/tenofovir DF both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- ephedrine
ephedrine and gentamicin both decrease serum potassium. Use Caution/Monitor.
- epinephrine
epinephrine and gentamicin both decrease serum potassium. Use Caution/Monitor.
- epinephrine racemic
epinephrine racemic and gentamicin both decrease serum potassium. Use Caution/Monitor.
- eprosartan
eprosartan increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- erythromycin base
erythromycin base will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- erythromycin ethylsuccinate
erythromycin ethylsuccinate will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- erythromycin lactobionate
erythromycin lactobionate will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- erythromycin stearate
erythromycin stearate will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- esmolol
esmolol increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- estradiol
gentamicin will decrease the level or effect of estradiol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.
- estrogens conjugated synthetic
gentamicin will decrease the level or effect of estrogens conjugated synthetic by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.
- estropipate
gentamicin will decrease the level or effect of estropipate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.
- ethacrynic acid
ethacrynic acid and gentamicin both decrease serum potassium. Use Caution/Monitor.
- etodolac
etodolac increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- felodipine
felodipine will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- fenoprofen
fenoprofen increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- flurbiprofen
flurbiprofen increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- formoterol
formoterol and gentamicin both decrease serum potassium. Use Caution/Monitor.
- fosphenytoin
fosphenytoin will decrease the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- furosemide
furosemide and gentamicin both decrease serum potassium. Use Caution/Monitor.
- hydrochlorothiazide
hydrochlorothiazide and gentamicin both decrease serum potassium. Use Caution/Monitor.
- ibuprofen
ibuprofen increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ibuprofen IV
ibuprofen IV increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. NSAIDs may decrease excretion of aminoglycosides; data only on premature infants.
ibuprofen IV increases levels of gentamicin by decreasing renal clearance. Use Caution/Monitor. Interaction mainly occurs in preterm infants. - indapamide
indapamide and gentamicin both decrease serum potassium. Use Caution/Monitor.
- indinavir
indinavir will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- indomethacin
indomethacin increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ioversol
ioversol and gentamicin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.
- irbesartan
irbesartan increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- isoproterenol
isoproterenol and gentamicin both decrease serum potassium. Use Caution/Monitor.
- ketoconazole
ketoconazole will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- ketoprofen
ketoprofen increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ketorolac
ketorolac increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ketorolac intranasal
ketorolac intranasal increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- labetalol
labetalol increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- levalbuterol
levalbuterol and gentamicin both decrease serum potassium. Use Caution/Monitor.
- levoketoconazole
levoketoconazole will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- loratadine
loratadine will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- lornoxicam
lornoxicam increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- losartan
losartan increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- magnesium supplement
magnesium supplement, gentamicin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Each enhance the neuromuscular blocking effect of the other; may have negative respiratory effects.
- meclofenamate
meclofenamate increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- mefenamic acid
mefenamic acid increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- meloxicam
meloxicam increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- mestranol
gentamicin will decrease the level or effect of mestranol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.
- metaproterenol
metaproterenol and gentamicin both decrease serum potassium. Use Caution/Monitor.
- methyclothiazide
methyclothiazide and gentamicin both decrease serum potassium. Use Caution/Monitor.
- metolazone
metolazone and gentamicin both decrease serum potassium. Use Caution/Monitor.
- metoprolol
metoprolol increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nabumetone
nabumetone increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nadolol
nadolol increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- naproxen
naproxen increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nebivolol
nebivolol increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nefazodone
nefazodone will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- nicardipine
nicardipine will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- nifedipine
nifedipine will decrease the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- nilotinib
nilotinib will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- norepinephrine
norepinephrine and gentamicin both decrease serum potassium. Use Caution/Monitor.
- olmesartan
olmesartan increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- oxaliplatin
gentamicin and oxaliplatin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- oxaprozin
oxaprozin increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- parecoxib
parecoxib increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- penbutolol
penbutolol increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- peramivir
gentamicin increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.
- phenobarbital
phenobarbital will decrease the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- phenytoin
phenytoin will decrease the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- pindolol
pindolol increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pirbuterol
pirbuterol and gentamicin both decrease serum potassium. Use Caution/Monitor.
- piroxicam
piroxicam increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- polymyxin B
gentamicin and polymyxin B both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- potassium acid phosphate
potassium acid phosphate increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- potassium chloride
potassium chloride increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- potassium citrate
potassium citrate increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- prabotulinumtoxinA
gentamicin increases effects of prabotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Aminoglycosides may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.
- propranolol
propranolol increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- quercetin
quercetin will decrease the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- rifampin
rifampin will decrease the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- rimabotulinumtoxinB
gentamicin, rimabotulinumtoxinB. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Aminoglycosides may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.
- ritonavir
ritonavir will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- sacubitril/valsartan
sacubitril/valsartan increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- salicylates (non-asa)
salicylates (non-asa) increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- salmeterol
salmeterol and gentamicin both decrease serum potassium. Use Caution/Monitor.
- salsalate
salsalate increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- sirolimus
sirolimus will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- sodium picosulfate/magnesium oxide/anhydrous citric acid
gentamicin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- sodium sulfate/?magnesium sulfate/potassium chloride
sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of gentamicin by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.
- sodium sulfate/potassium sulfate/magnesium sulfate
sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of gentamicin by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.
- sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol
gentamicin and sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.
- sotalol
sotalol increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- spironolactone
spironolactone increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- St John's Wort
St John's Wort will decrease the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- streptozocin
gentamicin and streptozocin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- succinylcholine
succinylcholine increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- sulfasalazine
sulfasalazine increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- sulindac
sulindac increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- tacrolimus
tacrolimus will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
gentamicin and tacrolimus both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. - teicoplanin
gentamicin and teicoplanin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.
- telmisartan
telmisartan increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- tenofovir DF
gentamicin and tenofovir DF both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
gentamicin increases levels of tenofovir DF by decreasing elimination. Use Caution/Monitor. - terbutaline
terbutaline and gentamicin both decrease serum potassium. Use Caution/Monitor.
- timolol
timolol increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- tobramycin
gentamicin and tobramycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- tobramycin inhaled
tobramycin inhaled and gentamicin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Avoid concurrent or sequential use to decrease risk for ototoxicity
- tolfenamic acid
tolfenamic acid increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- tolmetin
tolmetin increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- tolvaptan
tolvaptan will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
tolvaptan increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. - torsemide
torsemide and gentamicin both decrease serum potassium. Use Caution/Monitor.
- trazodone
trazodone will decrease the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- triamterene
triamterene increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
- trimagnesium citrate anhydrous
gentamicin, trimagnesium citrate anhydrous. Either increases effects of the other by Other (see comment). Use Caution/Monitor. Comment: Coadministration of aminoglycosides with magnesium may increase risk of neuromuscular weakness and paralysis.
- valsartan
valsartan increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- verapamil
verapamil will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- voclosporin
voclosporin, gentamicin. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.
Minor (73)
- aceclofenac
aceclofenac increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- acemetacin
acemetacin increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- adefovir
adefovir and gentamicin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- aspirin
aspirin increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- aspirin rectal
aspirin rectal increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- aspirin/citric acid/sodium bicarbonate
aspirin/citric acid/sodium bicarbonate increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- aztreonam
aztreonam, gentamicin. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Combination may be used synergistically against Pseudomonas spp. and Enterobacteriaceae.
- balsalazide
gentamicin will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- biotin
gentamicin will decrease the level or effect of biotin by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- calcium acetate
gentamicin decreases levels of calcium acetate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
- calcium carbonate
gentamicin decreases levels of calcium carbonate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
- calcium chloride
gentamicin decreases levels of calcium chloride by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
- calcium citrate
gentamicin decreases levels of calcium citrate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
- calcium gluconate
gentamicin decreases levels of calcium gluconate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
- celecoxib
celecoxib increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- choline magnesium trisalicylate
choline magnesium trisalicylate increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- clotrimazole
clotrimazole decreases levels of gentamicin by unknown mechanism. Minor/Significance Unknown.
- cordyceps
cordyceps decreases toxicity of gentamicin by unspecified interaction mechanism. Minor/Significance Unknown.
- cyanocobalamin
gentamicin decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
- cytarabine
cytarabine decreases effects of gentamicin by unspecified interaction mechanism. Minor/Significance Unknown.
- diclofenac
diclofenac increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- diflunisal
diflunisal increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- entecavir
gentamicin, entecavir. Either increases effects of the other by decreasing renal clearance. Minor/Significance Unknown. Coadministration with drugs that reduce renal function or compete for active tubular secretion may increase serum concentrations of either entecavir or the coadministered drug.
- etodolac
etodolac increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- fenoprofen
fenoprofen increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- fluconazole
fluconazole decreases levels of gentamicin by unknown mechanism. Minor/Significance Unknown.
- flurbiprofen
flurbiprofen increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- foscarnet
foscarnet and gentamicin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- ibuprofen
ibuprofen increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- indomethacin
indomethacin increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- ketoconazole
ketoconazole decreases levels of gentamicin by unknown mechanism. Minor/Significance Unknown.
- ketoprofen
ketoprofen increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- ketorolac
ketorolac increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- ketorolac intranasal
ketorolac intranasal increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- levoketoconazole
levoketoconazole decreases levels of gentamicin by unknown mechanism. Minor/Significance Unknown.
- lornoxicam
lornoxicam increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- magnesium chloride
gentamicin decreases levels of magnesium chloride by increasing renal clearance. Minor/Significance Unknown.
- magnesium citrate
gentamicin decreases levels of magnesium citrate by increasing renal clearance. Minor/Significance Unknown.
- magnesium hydroxide
gentamicin decreases levels of magnesium hydroxide by increasing renal clearance. Minor/Significance Unknown.
- magnesium oxide
gentamicin decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.
- magnesium sulfate
gentamicin decreases levels of magnesium sulfate by increasing renal clearance. Minor/Significance Unknown.
- meclizine
meclizine, gentamicin. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Ototoxicity of aminoglycoside may be masked.
- meclofenamate
meclofenamate increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- mefenamic acid
mefenamic acid increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- meloxicam
meloxicam increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- methoxyflurane
gentamicin and methoxyflurane both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- miconazole vaginal
miconazole vaginal decreases levels of gentamicin by unknown mechanism. Minor/Significance Unknown.
- nabumetone
nabumetone increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- naproxen
naproxen increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- noni juice
noni juice increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Minor/Significance Unknown.
- oxaprozin
oxaprozin increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- pantothenic acid
gentamicin will decrease the level or effect of pantothenic acid by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- parecoxib
parecoxib increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- paromomycin
gentamicin and paromomycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- pentamidine
gentamicin and pentamidine both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- perindopril
perindopril, gentamicin. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Mfr. recommends using combination with caution (interaction not specified).
- piperacillin
piperacillin increases effects of gentamicin by pharmacodynamic synergism. Minor/Significance Unknown.
- piroxicam
piroxicam increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- posaconazole
posaconazole decreases levels of gentamicin by unknown mechanism. Minor/Significance Unknown.
- pyridoxine
gentamicin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- pyridoxine (Antidote)
gentamicin will decrease the level or effect of pyridoxine (Antidote) by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- salicylates (non-asa)
salicylates (non-asa) increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- salsalate
salsalate increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- streptomycin
gentamicin and streptomycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- sulfasalazine
sulfasalazine increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- sulindac
sulindac increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- thiamine
gentamicin will decrease the level or effect of thiamine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- ticarcillin
ticarcillin decreases effects of gentamicin by altering metabolism. Minor/Significance Unknown. Increased risk in renal impairment.
- tolfenamic acid
tolfenamic acid increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- tolmetin
tolmetin increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- vancomycin
gentamicin and vancomycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- voriconazole
voriconazole decreases levels of gentamicin by unknown mechanism. Minor/Significance Unknown.
- zoledronic acid
gentamicin, zoledronic acid. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive hypocalcemia.
Adverse Effects
>10%
Neurotoxicity (vertigo, ataxia)
Gait instability
Ototoxicity (auditory, vestibular)
Nephrotoxicity (decreased CrCl)
Nephrotoxicity if trough >2 mg/L
1-10%
Edema
Rash
Reddening of skin
Itching
<1%
Drowsiness
Headache
Pseudomotor cerebri
Photosensitivity
Allergic reaction
Erythema
Anorexia
Nausea/vomiting
Weight loss
Increased salivation
Enterocolitis
Granulocytopenia
Agranulocytosis
Thrombocytopenia
Elevated LFTs
Burning
Stinging
Tremors
Muscle cramps
Weakness
Dyspnea
Warnings
Black Box Warnings
Patients treated with aminoglycosides should be under close clinical observation due to potential toxicity associated with their use
Neurotoxicity, manifested as bilateral auditory and vestibular ototoxicity, can occur in patients with preexisting renal impairment and in patients with normal renal function treated at higher doses and/or for periods longer than those recommended; high-frequency deafness usually occurs first and can be detected only with audiometric testing
Aminoglycosides are potentially nephrotoxic; risk is greater in patients with impaired renal function and in those who receive high doses or prolonged therapy; rarely, nephrotoxicity may not become apparent until the first few days after cessation of therapy
Use with caution in premature infants and neonates because of renal immaturity and the resulting prolongation of serum half-life of the drug
Monitor eighth cranial nerve and renal function; especially in patients with known or suspected reduced renal function at onset of therapy and also in patients with normal function at the beginning of therpay but that develop signs of rena dysfunction during therapy; examine urine for increased excretion of protein, decreased specific gravity and presence of cells; serial audiograms should be obtained when possible; adjust the dose or discontinue therapy if there is evidence of ototoxicity or nephrtoxicity
Neuromuscular blockade and respiratory paralysis have been reported following parenteral injection, topical instillation (as in orthopedic and abdominal irrigation or in local treatment of empyema), and oral use of aminoglycosides, especially when given soon after anesthesia or muscle relaxants; if blockage occurs, calcium salts may reverse these phenomena, but mechanical respiratory assistance may be necessary
Avoid concurrent or sequential use of neurotoxic and/or nephrotoxic drugs, including other aminoglycosides (eg, amikacin, streptomycin, neomycin, kanamycin, paromomycin)
Cumulative listing of drugs to avoid from all aminoglycosides; package inserts includes amphotericin B, bacitracin, cephaloridine, cisplatin, colistin, polymyxin B, vancomycin, and viomycin
Avoid potent diuretics (eg, ethacrynic acid, furosemide) because they increase risk of ototoxicity; when administered intravenously, diuretics may enhance aminoglycoside toxicity by altering antibiotic concentrations in serum and tissue
Contraindications
Prior aminoglycoside toxicity or hypersensitivity
Cautions
Patients treated withaminoglycosides should be under close clinical observation; high risk of toxicity associated with their use
Risk of ototoxicity; tinnitus or vertigo may be indications of vestibular injury and impending bilateral irreversible damage; discontinue therapy if signs of ototoxicity occur
Risk of nephrotoxicity; other factors that increase patient risk of ototoxicity include advanced age and dehydration
Narrow therapeutic index (not intended for long-term therapy)
Caution in renal failure (not on dialysis), myasthenia gravis, hypocalcemia, and conditions that depress neuromuscular transmission
Adjust dose in renal impairment
Endocarditis prophylaxis (GI, GU procedure): AHA Guidelines recommend only for high-risk patients
Diuretics may enhance aminoglycoside toxicity by altering antibiotic concentration in serum and tissue; certain diuretics by themselves may cause ototoxicity; avoid potent diuretics, including ethacrynic acid or furosemide
Use caution in patients with electrolyte abnormalitie including hypocalcemia, hypomagnesemia, or hypokelemia
Use caution in patients with neuromuscular disorders, including myasthenia gravis
Use caution in patients with hearing and renal impairment
Pregnancy & Lactation
Pregnancy category: D
Lactation: Enters breast milk; use with caution (AAP Committee states "compatible with nursing")
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Aminoglycoside antibiotic for coverage of gram-negative bacteria, including Pseudomonas species; synergistic with beta lactamase against enterococci; interferes with bacterial protein synthesis by binding to 30S and 50S ribosomal subunits
Absorption
Peak plasma time: IM (30-90 min); IV (30 min after 30-min infusion)
Distribution
Gentamicin crosses placenta; relative diffusion from blood into CSF is minimal even with inflammation
CSF-to-blood level ratio: Normal meninges (minimal); inflamed meninges (10-30%)
Protein bound: <30%
Vd: Neonates (0.4-0.6 L/kg); children: (0.3-0.35 L/kg); adults: (0.2-0.3 L/kg); Vd increased by edema, ascites, and fluid overload and decreased by dehydration
Elimination
Half-life: 2-3 hr (NRF)
Renal clearance: Directly related to renal function
Excretion: Urine (70% recovered as unchanged drug in patients with NRF)
Administration
IV Incompatibilities
Additive: Ampho B, ampicillin, cefazolin, dopamine, furosemide, heparin
Syringe: Ampicillin, heparin
Y-site: Furosemide, heparin
Not spec: Carbenicillin
IV Compatibilities
Additive: cimetidine, clindamycin, verapamil
Syringe: clindamycin
Y-site: Amiodarone, esmolol, vitamins B/C
IV Preparation
Dilute single dose in 50-200 mL NS or D5W
IV Administration
Infuse over 30 min-2 hr
After infusion, flush line with NS or D5W
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Gentak ophthalmic (eye) - | 0.3 % (3 mg/gram) ointment |  | |
| gentamicin injection - | 20 mg/2 mL vial |  | |
| gentamicin injection - | 40 mg/mL vial |  | |
| gentamicin injection - | 40 mg/mL vial |  | |
| gentamicin injection - | 40 mg/mL vial |  | |
| gentamicin topical - | 0.1 % ointment |  | |
| gentamicin topical - | 0.1 % ointment |  | |
| gentamicin topical - | 0.1 % cream |  | |
| gentamicin topical - | 0.1 % cream |  | |
| gentamicin topical - | 0.1 % cream |  | |
| gentamicin topical - | 0.1 % cream |  | |
| gentamicin topical - | 0.1 % ointment |  | |
| gentamicin topical - | 0.1 % ointment |  | |
| gentamicin topical - | 0.1 % cream |  | |
| gentamicin topical - | 0.1 % cream |  | |
| gentamicin topical - | 0.1 % ointment |  | |
| gentamicin topical - | 0.1 % ointment |  | |
| gentamicin ophthalmic (eye) - | 0.3 % drops |  | |
| gentamicin ophthalmic (eye) - | 0.3 % drops |  | |
| gentamicin ophthalmic (eye) - | 0.3 % drops |  | |
| gentamicin ophthalmic (eye) - | 0.3 % drops |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
gentamicin injection
GENTAMICIN - INJECTION
(jen-ta-MYE-sin)
COMMON BRAND NAME(S): Garamycin
WARNING: This medication can cause serious kidney problems and nerve damage, resulting in permanent hearing loss (including deafness or decreased hearing) and balance problems. The risk is increased if you are older, already have kidney disease, or if you have a severe loss of body water (dehydration). Your risk is also increased if you receive high doses, or with longer use of this medication.Tell your doctor right away if you notice ringing/roaring sounds in the ears, hearing loss, dizziness, or an unusual decrease in the amount of your urine.Careful monitoring by your doctor will reduce the risk of these side effects. Monitoring may include hearing, kidney, urine, and drug blood level tests.Avoid other medications that may increase your risk for these serious side effects if taken together with gentamicin. See also Drug Interactions section.
USES: This medication is used to prevent or treat a wide variety of bacterial infections. Gentamicin belongs to a class of drugs known as aminoglycoside antibiotics. It works by stopping the growth of bacteria.
HOW TO USE: This medication is given by injection into a vein or muscle as directed by your doctor, usually every 8 hours. The dosage is based on your medical condition, weight, and response to treatment. Laboratory tests (such as kidney function, levels of drug in the blood) may be performed to help find the best dose for your condition.If you are giving this medication to yourself at home, learn all preparation and usage instructions from your health care professional. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard medical supplies safely.For the best effect, use this antibiotic at evenly spaced times. To help you remember, use this medication at the same time(s) every day.Continue to use this medication until the full prescribed amount is finished, even if symptoms disappear after a few days. Stopping the medication too early may allow bacteria to continue to grow, which may result in a return of the infection.Tell your doctor if your condition lasts or gets worse.
SIDE EFFECTS: See also Warning section.Nausea, vomiting, stomach upset, or loss of appetite may occur. Pain/irritation/redness at the injection site may rarely occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: numbness/tingling, muscle twitching or weakness, seizure.This medication may rarely cause a severe intestinal condition due to a bacteria called C. difficile. This condition may occur during treatment or weeks to months after treatment has stopped. Tell your doctor right away if you develop: diarrhea that doesn't stop, abdominal or stomach pain/cramping, blood/mucus in your stool.If you have these symptoms, do not use anti-diarrhea or opioid products because they may make symptoms worse.Use of this medication for prolonged or repeated periods may result in oral thrush or a new yeast infection. Contact your doctor if you notice white patches in your mouth, a change in vaginal discharge, or other new symptoms.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any of the following symptoms of a serious allergic reaction: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before using gentamicin, tell your doctor or pharmacist if you are allergic to it; or to other aminoglycoside antibiotics (such as tobramycin, amikacin); or if you have any other allergies. This product may contain inactive ingredients (such as sulfites), which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: cystic fibrosis, hearing problems (including deafness, decreased hearing), kidney problems, low blood minerals (including potassium, magnesium, calcium), myasthenia gravis, Parkinson's disease.Gentamicin may cause live bacterial vaccines (such as typhoid vaccine) to not work well. Tell your health care professional that you are using gentamicin before having any immunizations/vaccinations.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Older adults may be more sensitive to the effects of this drug, especially kidney damage.This medication is not recommended for use during pregnancy. Although there have been reports of harm in babies born to women using similar drugs, the risk for harm may not be the same with this drug. Discuss the risks and benefits with your doctor.This drug passes into breast milk in small amounts. However, many doctors consider breastfeeding safe while using this medication. Consult your doctor before breastfeeding.
DRUG INTERACTIONS: See also Warning section.Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Other medications that may affect the kidneys or hearing may increase the risk of kidney damage or hearing loss if taken with gentamicin. Some affected drugs include: amikacin, tobramycin, amphotericin B, cidofovir, cisplatin, polymyxin B, cephalosporins such as cephaloridine, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, among others.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.
NOTES: Laboratory and/or medical tests (such as kidney function, levels of drug in your blood) may be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.
MISSED DOSE: It is important to get each dose of this medication as scheduled. If you miss a dose, ask your doctor or pharmacist right away for a new dosing schedule. Do not double the dose to catch up.
STORAGE: Consult the product instructions and your pharmacist for storage details. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised December 2021. Copyright(c) 2022 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
Adding plans allows you to compare formulary status to other drugs in the same class.
To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.
